Colon and Lung cancer Flashcards
Fluorouracil IV only
MOA
FU and 5 FU are the same
Interferes with DNA and RNA Synthesis
- 2 Active metabolites
- FUMP- Incorporate into RNA inhibits cell growth
- FdUMP- Inhibits thymidylate synthetase, depletes thymidine tiphosphate
- DUAL mechanism of action S phase cell death
Capecitabine
MOA
Oral version of 5FU
5-FU and Capecitabine SEs?
How are they given?
- Mucositis
- Diarrhea
- N/V
- Myelosuppression
- Alopecia
- Hand-foot syndrome (higher with capecitabine blisters on hands and feet)
What medication enhances the killing of 5-FU?
What regimens are these not used in?
Leucovorin
- Not used in capecitabine regimens
- NOT CHEMOTHERAPY!!
Forms complex with FdUMP and thymidylate synthase. DUMP DNA
Oxaliplatin MOA?
Platinum agent
Forms/ inner and intra platinum DNA crosslinks
Crossling prevents DNA synth/replication
Oxaliplatin is usually dropped first due to SEs
Oxaliplatin SEs
- Cold neuropathy- Acute and chronic. hursts when youtouch cold shit. gloves to get milk
- Hypersensitivity Reactions usually takes like 6-8 cycles before you see it
- Nephrotox
- Ototoxicity
Irinotecan
MOA
Active metabolite
Topo 1 inhibitor
prevents re-ligation of single stranded DNA breaks
Damages dsDNA Cytotoxic
Active metabolite SN38 if someone has a mutation that decreases UGT1A1 you can see increased accumulation of this and increased toxicity
Irinotecan
AEs?
How to treat?
- Diarrhea
- Early within 24 hours- Atropine
- Late- over 24 hours loperamide
Bevacizumab
MOA?
Binds to/neutralizes vascular endothelial growth factor VEGF
Reduces O2 supply reduces cell growth
Bevacizumab
SEs?
Thromboemboli
Or Hemorrhage
CLOTTING OR BLEEDING
Have to hold therapy 4 weeks before and after with any type of surgery because of bleed risk
Ramucirumab
Inhibits VEGF2
What do you have to give with Ramucirumab prior to infusion?
H1 antagonist IV
What are the hallmarks for VEG Fs?
Impaired wound healing
HTN
EDEMA
Thrombosis
Hemmorrage
Proteinuria
Ziv-Aflibercept
MOA?
Binds up free VEGF thats floating arounf
Soluble Decoy Receptor
Ziv aflibercept SEs?
WHen is it given?
Hemorrage
Impaired wound heal
VTE
Proteinuria
Given in combination with FOLFIRI after failure of Oxaliplatin based Regimen
Cetuximab
MOA?
Binds to EGFR
Completely inhibits binding of EGFR and other lugands
Blocks phosphorylation and activation of intracellular tyrosine kinases- this inhibits cell survival, growth, proliferation and transformation
Cells with RAS mutations are uneffected by EGFR inhibition
Cetuximab
SEs?
- Hypersensitivity Rxns BBW
- Acneiform Rash (itching as well and its not acne)
- Pruritis
- N,D, Constipation
- Infection
- E+ Disurbances
- Premedication with DIphen, fami, albuterol
Panitumumab
MOA
EGFR inhibitor HUMAN
Ancneform rash/pruritis
Pulmonary Toxicity
What medications do you need to test for RAS mutation
Pantitumumab
Cetuximab
have to have KRAS wildtype
or just a EGFR mutation
Regarafenib
MOA
Multikinase inhibitor
suppression of tumor growth
Regorafenib
SEs?
hepatoxicity and Hypertension
Regorafenib how do you take it and when is it used?
What Drug interactions?
after failure of multiple regimens
Swallow tablet whole with water
Following a low fat meal <600 calories
CYP3A4
Trifluridine and Tipiracil
MOA
Whats the tipiracil for?
SEs?
Super 5-FU
Product binds to thymidylate synthase
DNA strand break formation
Tipiracil is there to prevent the degredation of Trifluridine By inhibiting thymidine phosphorylation
N/V/Diarrhea
Myelosuppression
1 hour after morning and evening meals
Pemetrexed
What is it?
What two things need to be given beforeand when?
What should you avoid
Folic Acid 7 days prior to first day of the first cycle
Vitamin B1 7 days prior as well- Give every 3 cycles there after
Dont give NSAIDs during
